Single-Stage Midline Unifocalization Is Associated With Excellent Outcomes in Infants of All Ages

Area of Science:

• Pediatric Cardiology
• Congenital Heart Surgery
• Medical Research

Background:

• Tetralogy of Fallot with pulmonary atresia and major aortopulmonary collateral arteries is a complex defect.
• Historically, single-stage unifocalization was recommended at 3-6 months.
• Many patients present for treatment after 6 months of age.

Purpose of the Study:

• To evaluate surgical outcomes of single-stage unifocalization based on patient age at repair.
• To compare outcomes for infants undergoing repair between 3 and 12 months of age.
• To determine if age at repair influences the need for pulmonary artery reinterventions.

Main Methods:

• Retrospective review of 220 patients undergoing unifocalization between 3 and 12 months.
• Patients were grouped by age: 3.0-4.9, 5.0-5.9, 6.0-7.9, and 8.0-11.9 months.
• Competing risk regression analyses were used to compare outcomes.

Main Results:

• Complete single-stage repair was achieved in 79% of patients, with no significant difference across age groups.
• Early mortality was 4%.
• Older infants (8.0-11.9 months) showed significantly fewer pulmonary artery reinterventions compared to the youngest group.

Conclusions:

• Excellent surgical outcomes are achievable with single-stage unifocalization across various infant ages.
• Surgical timing should be individualized based on clinical and anatomical factors.
• Older, clinically appropriate infants may benefit from a lower risk of pulmonary artery reinterventions.